Smoking verification and the risk of myocardial infarction

Lung cancer in never smokers: Distinct population-based patterns by age, sex, and race/ethnicity

OBJECTIVES

Epidemiological patterns for lung cancer among never smokers (LCNS) are largely unknown, even though LCNS cases comprise 15% of lung cancers. Past studies were based on epidemiologic or health system cohorts, and not fully representative of the underlying population. The objective was to analyze rates (and trends) of LCNS by sex, age group, and race and ethnicity based on all-inclusive truly population-based sources.

MATERIALS AND METHODS

Individual-level data from 2014 to 2018 on smoking status among microscopically-confirmed lung cancer cases from Florida's cancer registry were combined with population denominators adjusted with NHIS data on smoking prevalence to compute population-based LCNS incidence rates and rate ratios. Incidence rates and proportional mortality were ranked against other cancers. Joinpoint regression analyses examined trends.

RESULTS

Proportions of LCNS ranged from 9% among White men to 83% among Chinese women. Overall, LCNS was 13% (IRR 1.13, 95%CI 1.08-1.17) more common among men than women, but variation occurred by age group, with female rates exceeding male in younger ages. Age-adjusted rates per 100,000 were highest among Asian/Pacific Islander (API) men and women (15.3 and 13.5, respectively) and Black populations (14.6, 12.9), intermediate for White (13.2, 11.8) and lowest among the Hispanic population (12.1, 10.6). Among API women, LCNS was the second leading cause of cancer death, surpassed only by breast cancer. LCNS trends were stable over time.

CONCLUSION

LCNS is the 11th most frequently occurring cancer in men and 8th in women. LCNS differences by race/ethnicity are small, within a 15% range of the White population's rates. Surprisingly, API men and women have the highest LCNS rates and proportional mortality. As smoking prevalence decreases in the US, LCNS cases will inevitably increase, warranting inquiry into risk factors across the lifespan.

Smoking is the dominating modifiable risk factor in younger patients with STEMI

AIMS

Smoking is an important modifiable risk factor for myocardial infarction. It is unclear whether smoking habits at the time of an incident ST-segment elevation myocardial infarction (STEMI) differ across age groups and sex.

METHODS AND RESULTS

We included patients with incident STEMI registered in the Western Denmark Heart Registry from 2005 to 2015 (n=9914). Patients were divided into four age groups (30-49, 50-59, 60-69 and ⩾70 years) with the latter serving as reference. Smoking was the most prevalent modifiable risk factor in 30-49-year-old patients (74% vs. hypertension 15%, hyperlipidaemia 10% and diabetes 7%). The smoking prevalence decreased with increasing age, while treatment for hypertension, hyperlipidaemia and diabetes increased with increasing age. Smoking was five times (odds ratio (OR) 5.15; 95% confidence interval (CI) 4.37-6.07) more prevalent among 30-49-year-old patients with STEMI than the reference group. Differences according to sex were significant as the OR for current smoking in women was 9.88 (95% CI 6.94-14.08) compared to OR 3.78 (95% CI 3.12-4.58) in men.

CONCLUSIONS

Despite public information campaigns and general warnings, smoking remains the most prevalent modifiable risk factor in younger patients with STEMI.

Sub-acute administration of lower doses of nicotine caused sex-dependent improvement of renal function in Wistar rats

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Exposure to nicotine is associated with sex-dependent variation in electrolyte disturbances.

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Lower doses of sub-acute nicotine administration enhanced renal function.

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Nicotine-enhanced renal function is more pronounced in female than in male Wistar rats.

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Nicotine-enhanced renal function may be mediated through α7-nAchR.

The adverse and beneficial health effects of nicotine (NIC), the major alkaloid found in cigarettes and tobacco, are controversial. Most studies on NIC have focused on its effects on cardiovascular and nervous functions. This study aimed at determining dose- and sex-specific effects of sub-acute (28 days) NIC administration on some indices of kidney function in Wistar rats. Forty rats (20 males and 20 females), 8–9 weeks old (each housed in separate metabolic cage), were used for this study such that graded doses of NIC (1, 2 and 4 mg/kg i.p. for 28 days) were administered to both sexes while each control received distilled water at 0.2 mL/100 g i.p. Blood was collected under ketamine anesthesia (10 mg/kg i.m) for analyses and results obtained were compared at p < 0.05. The result showed beneficial alterations in plasma and urine level of creatinine, urea and uric acid (p < 0.05) as well as plasma and urine electrolyte level (Na⁺ and K⁺) in both sexes (p < 0.05). Also, there was significant improvement in creatinine clearance (p < 0.05) with no appreciable difference in their histological examination. Although these beneficial effects were more pronounced in the female than in the male (p < 0.05), administration at the highest dose showed potentially deleterious alterations from normal beneficial trend (p < 0.05) in both sexes. It was concluded that sub-acute administration of lower doses of NIC improves kidney function of Wistar rats; an effect that was more pronounced in the females than their male counterparts.

A retrospective cross-sectional study on the association between tobacco smoking and incidence of ST-segment elevation myocardial infarction and cardiovascular risk factors

BACKGROUND

Cigarette smoking is a well-established risk factor for the development of coronary heart disease. However, the relationship between smoking and acute ST-segment elevation myocardial infarction (STEMI) is less well described.

OBJECTIVE

To determine the relative risk of acute STEMI in smokers and ex-smokers, compared with individuals who had never smoked.

METHODS

This observational study studied all patients with STEMI undergoing percutaneous coronary intervention (PCI) in South Yorkshire, UK from 1 January 2009 to 6 April 2012. Additional contemporary demographical data for the South Yorkshire population, supplied by the Office for National Statistics, allowed derivation of the incidence rate of STEMI in South Yorkshire-both overall and stratified by smoking status. Incidence rate ratios and population attributable risk (PAR) were calculated to quantify STEMI risk.

RESULTS

There were 1715 STEMIs in 1680 patients during the study period. Smoking status was obtained in 96.2% patients. The prevalence of smoking was 47.3% in patients with STEMI and 22.0% in the general population. In patients with STEMI, smokers were ∼10 years younger, mean (SD) 57.2 (11.1) years, than never-smokers, 66.4 (12.1) years, and ex-smokers, 67.9 (11.9) years. The age-standardised incident rate ratio of STEMI was 5.2 (4.5-6.1) for current smokers and 1.1 (1.0-1.3) for ex-smokers, with the reference group being never-smokers for both. Almost 50% of STEMIs were attributable to smoking (PAR=48.3%).

CONCLUSION

Cigarette smoking is associated with a fivefold increased risk of STEMI. Smoking cessation reduced this risk to a level similar to never-smokers.

Cigarette smoking trends among U.S. working adult by industry and occupation: findings from the 2004-2012 National Health Interview Survey

OBJECTIVE

To examine trends in age-adjusted cigarette smoking prevalence among working adults by industry and occupation during 2004-2012, and to project those prevalences and compare them to the 2020 Healthy People objective (TU-1) to reduce cigarette smoking prevalence to ≤12%.

METHODS

We analyzed the 2004-2012 National Health Interview Survey (NHIS) data. Respondents were aged ≥18 years working in the week prior to the interview. Temporal changes in cigarette smoking prevalence were assessed using logistic regression. We used the regression model to extrapolate to the period 2013-2020.

RESULTS

Overall, an estimated 19.0% of working adults smoked cigarettes: 22.4% in 2004 to 18.1% in 2012. The largest declines were among workers in the education services (6.5%) industry and in the life, physical, and social science (9.7%) occupations. The smallest declines were among workers in the real estate and rental and leasing (0.9%) industry and the legal (0.4%) occupations. The 2020 projected smoking prevalences in 15 of 21 industry groups and 13 of the 23 occupation groups were greater than the 2020 Healthy People goal.

CONCLUSIONS

During 2004-2012, smoking prevalence declined in the majority of industry and occupation groups. The decline rate varied by industry and occupation groups. Projections suggest that certain groups may not reach the 2020 Healthy People goal. Consequently, smoking cessation, prevention, and intervention efforts may need to be revised and strengthened, particularly in specific occupational groups.

Lung cancer incidence in never smokers

PURPOSE

Lung cancer is a leading cause of cancer death worldwide. Although smoking remains the predominant cause of lung cancer, lung cancer in never smokers is an increasingly prominent public health issue. However, data on this topic, particularly lung cancer incidence rates in never smokers, are limited.

METHODS

We reviewed the existing literature on lung cancer incidence and mortality rates among never smokers and present new data regarding rates in never smokers from the following large, prospective cohorts: Nurses' Health Study; Health Professionals Follow-Up Study; California Teachers Study; Multiethnic Cohort Study; Swedish Lung Cancer Register in the Uppsala/Orebro region; and First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study.

RESULTS

Truncated age-adjusted incidence rates of lung cancer among never smokers age 40 to 79 years in these six cohorts ranged from 14.4 to 20.8 per 100,000 person-years in women and 4.8 to 13.7 per 100,000 person-years in men, supporting earlier observations that women are more likely than men to have non-smoking-associated lung cancer. The distinct biology of lung cancer in never smokers is apparent in differential responses to epidermal growth factor receptor inhibitors and an increased prevalence of adenocarcinoma histology in never smokers.

CONCLUSION

Lung cancer in never smokers is an important public health issue, and further exploration of its incidence patterns, etiology, and biology is needed.